Robert D Childers, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

036073486 Issued in IL

Practice address

400 Maple Summit Rd
Ste 300
Jerseyville, IL 62052-2028

Phone

(618) 498-8470

Fax

(618) 498-8488

NPI assigned

Sep 20, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 4

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Urology

Education

Other, 1981

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jersey Community Hospital Hospital, Jerseyville, IL, CCN 140059
• Community Hospital of Staunton Hospital, Staunton, IL, CCN 141306

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rchilders@direct.iuhealth.org
• Direct secure messaging: rchildersmd389404@carlehiedirect.net
• Direct secure messaging: rchilders312289@direct-ehr-ssmhc.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Robert D Childers MD SC

  • Clinic/Center
  • Jerseyville, IL
  • NPI 1699962498
  Medicare reassignment Authorized official
• Methodist Medical Center of Illinois

  • Rehabilitation Hospital Unit
  • Peoria, IL
  • NPI 1982656575
  Medicare reassignment NPD
• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Community Hospital of Staunton

  • Critical Access Hospital
  • Staunton, IL
  • NPI 1750308631
  Care Compare affiliation
• Jersey Community Hospital

  • General Acute Care Hospital
  • Jerseyville, IL
  • NPI 1184630519
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1760477376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 28",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620520028",
            "telephone_number": "618-498-8470",
            "fax_number": "618-498-8488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MAPLE SUMMIT RD",
            "address_2": "STE 300",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620522028",
            "telephone_number": "618-498-8470",
            "fax_number": "618-498-8488"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Good Samaritan Way Ste 420",
            "address_purpose": "LOCATION",
            "city": "Mount Vernon",
            "state": "IL",
            "postal_code": "628642478",
            "country_code": "US",
            "telephone_number": "618-899-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5165 McCarty Ln",
            "address_purpose": "LOCATION",
            "city": "Lafayette",
            "state": "IN",
            "postal_code": "479058764",
            "country_code": "US",
            "telephone_number": "765-448-8000",
            "fax_number": "765-448-7619",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHILDERS",
        "first_name": "ROBERT",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IN",
            "license": "01093287A",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036073486",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036073486",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2822",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0006000528",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "340014235",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rchilders312289@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "rchilders312289@direct-ehr-ssmhc.com",
            "address_1": "2 Good Samaritan Way Ste 420",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642478",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmhc.com/fhir/api/FHIR/DSTU2/",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHIR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2 Good Samaritan Way Ste 420",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628642478",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rchilders@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "5165 McCarty Ln",
            "city": "Lafayette",
            "state": "IN",
            "country_code": "US",
            "postal_code": "479058764",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Urology Physician in Jerseyville, IL
• Providers in Jerseyville, IL by specialty
• Urology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.